Journal of critical care最新文献

{"title":"Heliox ventilation in elderly, hypertensive ICU patients improves microcirculation: A randomized controlled study","authors":"Lili Zhou ,&nbsp;Jing Lin ,&nbsp;Mingkai Zhuang ,&nbsp;Yue Wang ,&nbsp;Qinyong Weng ,&nbsp;Hui Zhang","doi":"10.1016/j.jcrc.2024.154897","DOIUrl":"10.1016/j.jcrc.2024.154897","url":null,"abstract":"<div><h3>Background</h3><p>Conventional mechanical ventilation has adverse impacts on the hemodynamics of elderly, hypertensive ICU patients. Limited studies have addressed ways to ameliorate these negative effects. This study aimed to determine whether heliox ventilation could improve the hemodynamics, especially microcirculation, of elderly, hypertensive patients undergoing mechanical ventilation.</p></div><div><h3>Methods</h3><p>Thirty-eight patients, over the age of 65 with essential hypertension who underwent invasive mechanical ventilation treatment, were divided into two groups: a control group of nitrogen‑oxygen ventilation (<em>n</em> = 19) and an experimental group of heliox ventilation (n = 19). The control group received conventional room air ventilation and the experimental group adopted the innovative, closed heliox ventilation technique. Changes in blood pressure, heart rate (HR), peripheral oxygen saturation (SpO₂), central venous oxygen saturation (ScvO₂), regional cerebral oxygen saturation (rSO₂), lactic acid (Lac) and airway pressure were measured at 0,1,2,3 h under volume-controlled ventilation (VCV) mode throughout the study. Sublingual microcirculation parameters were additionally measured at 0 h and 3 h of ventilation treatment.</p></div><div><h3>Results</h3><p>SpO₂ in both groups increased after 1 h of ventilation compared with 0 h (<em>p</em> &lt; 0.001), subsequently remaining stable. Compared with the control group, the experimental group showed a decrease in airway pressure and Lac, while blood pressure, ScvO₂, and rSO₂ increased (<em>p</em> &lt; 0.05). Moreover, the sublingual microcirculation indexes in the experimental group improved compared with the control group (<em>p</em> &lt; 0.05).</p></div><div><h3>Conclusions</h3><p>Heliox ventilation improves blood pressure and microcirculation in elderly hypertensive patients and may resolve the limitations of traditional nitrogen‑oxygen ventilation.</p></div><div><h3>Trial registration</h3><p>This trial was registered. The Chinese trial registration number is ChiCTR2100043945. The date of registration is 6-3-2021.</p></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"84 ","pages":"Article 154897"},"PeriodicalIF":3.2,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0883944124003848/pdfft?md5=26bad3591c22e37355cac7d9f21dfc5e&pid=1-s2.0-S0883944124003848-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Normalization of IL-6 levels is associated with survival in critically ill patients with COVID-19","authors":"Anahita Mostaghim ,&nbsp;Neha A. Sathe ,&nbsp;F. Linzee Mabrey ,&nbsp;Sharon Sahi ,&nbsp;Nick O'Connor ,&nbsp;Eric D. Morrell ,&nbsp;Michael Fitzpatrick ,&nbsp;Craig H. Smith ,&nbsp;Mark M. Wurfel ,&nbsp;W. Conrad Liles ,&nbsp;Pavan K. Bhatraju","doi":"10.1016/j.jcrc.2024.154896","DOIUrl":"10.1016/j.jcrc.2024.154896","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"84 ","pages":"Article 154896"},"PeriodicalIF":3.2,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141954150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of continuous renal replacement therapy versus peritoneal dialysis as a renal replacement therapy modality in patients undergoing Venoarterial extracorporeal membrane oxygenation","authors":"Peerapat Thanapongsatorn ,&nbsp;Nisha Wanichwecharungruang ,&nbsp;Nattachai Srisawat","doi":"10.1016/j.jcrc.2024.154895","DOIUrl":"10.1016/j.jcrc.2024.154895","url":null,"abstract":"<div><h3>Introduction</h3><p>The optimal modality for renal replacement therapy (RRT) in patients venoarterial extracorporeal membrane oxygenation (VA-ECMO) remains unclear. This study aimed to compare outcomes between continuous renal replacement therapy (CRRT) and peritoneal dialysis (PD) in VA-ECMO patients.</p></div><div><h3>Methods</h3><p>This single-center retrospective study included VA-ECMO patients who developed AKI and subsequently required CRRT or PD. Data on patient demographics, comorbidities, clinical characteristics, RRT modality, and outcomes were collected. The primary outcome was in-hospital mortality, with secondary outcomes including length of stays, RRT durations, and complications associated with RRT.</p></div><div><h3>Results</h3><p>A total of 43 patients were included (72.1% male, mean age 58.2 ± 15.7 years). Of these, 21 received CRRT and 22 received PD during ECMO therapy. In-hospital mortality rates did not significantly differ between CRRT and PD groups (80.9% vs 90.9%, <em>p</em> = 0.35). However, PD was associated with a higher incidence of catheter-related complications, including malposition (31.8% vs 4.7%, <em>p</em> = 0.046), infection (22.7% vs 4.7%, <em>p</em> = 0.19), and bleeding (18.2% vs 9.5%, <em>p</em> = 0.66), respectively.</p></div><div><h3>Conclusion</h3><p>Among patients receiving VA-ECMO-supported RRT, our study revealed comparable in-hospital mortality rates between CRRT and PD, although PD was associated with a higher incidence of catheter-related complications.</p></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"84 ","pages":"Article 154895"},"PeriodicalIF":3.2,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous glucose monitoring versus conventional glucose monitoring in the ICU: A randomized controlled trial","authors":"Chen Chu ,&nbsp;Jian Li ,&nbsp;XiaoDong Yang ,&nbsp;HuiJing Zhao ,&nbsp;ZaiXian Wu ,&nbsp;RuoXin Xu ,&nbsp;JianLing Gao","doi":"10.1016/j.jcrc.2024.154894","DOIUrl":"10.1016/j.jcrc.2024.154894","url":null,"abstract":"<div><h3>Purpose</h3><p>This study evaluated the clinical utility of <!--> <!-->continuous glucose monitoring system (CGMS) in critically ill patients.</p></div><div><h3>Methods</h3><p>In this randomized controlled trial, we randomly assigned critically ill participants with diabetes or stress-induced hyperglycemia to the CGMS group (<em>n</em> = 48) or to the conventional point-of-care monitoring (POCM) group (n = 48). The glucose values and clinical outcome were compared between the two group. The primary endpoint was 28-day mortality after intensive care unit admission.</p></div><div><h3>Results</h3><p>The 28-day mortality was not significantly different between the CGMS and POCM group (20.8% vs 31.3%, <em>P</em> = 0.25). The mean glucose, time-weighted average glucose, glucose standard deviation and time in range (3.9–10.0) were significantly improved in the CGMS group (all <em>P</em> &lt; 0.05).</p></div><div><h3>Conclusion</h3><p>Compared with conventional POCM, CGMS did not decrease the 28-day mortality in critically ill participants with diabetes or stress-induced hyperglycemia. But CGMS may improve the glycemic control and may be increasingly used in critically ill patients.</p></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"84 ","pages":"Article 154894"},"PeriodicalIF":3.2,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0883944124003812/pdfft?md5=b486439f1f0bf0c4901f265f4401b4b8&pid=1-s2.0-S0883944124003812-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antisense therapy to block the Kallikrein-kinin pathway in COVID-19: The ASKCOV randomized controlled trial","authors":"Fernando G. Zampieri ,&nbsp;Glauco Adrieno Westphal ,&nbsp;Maria Adelaide Dos Santos ,&nbsp;Samara P.C. Gomes ,&nbsp;Jackeline O. Gomes ,&nbsp;Karina L. Negrelli ,&nbsp;Renato H.N. Santos ,&nbsp;Luciana M. Ishihara ,&nbsp;Tamiris A. Miranda ,&nbsp;Ligia N. Laranjeira ,&nbsp;Nanci Valeis ,&nbsp;Eliana Vieira Santucci ,&nbsp;Vicente Cés de Souza Dantas ,&nbsp;Otávio Gebara ,&nbsp;Danny M. Cohn ,&nbsp;Gustavo Buchele ,&nbsp;Mariano Janiszewski ,&nbsp;Flávio Geraldo de Freitas ,&nbsp;Felipe Dal-Pizzol ,&nbsp;Alexandre de Matos Soeiro ,&nbsp;Alexandre B. Cavalcanti","doi":"10.1016/j.jcrc.2024.154892","DOIUrl":"10.1016/j.jcrc.2024.154892","url":null,"abstract":"<div><h3>Purpose</h3><p>To assess the effect of antisense therapy to block kallikrein-kinin pathway in COVID-19 patients.</p></div><div><h3>Material and methods</h3><p>Randomized, placebo-controlled, double blind, controlled trial enrolling hospitalized COVID-19 patients that required supplementary oxygen to sustain peripheral oxygen saturation. Key exclusion criteria included use of mechanical ventilation or vasopressors, and patients with more than 10 days since symptom onset or more than 48 h of oxygen use. Patients were randomized to either one subcutaneous dose of ISIS721744, an antisense that blocks prekallikrein, or placebo. The primary outcome was the number of days alive and free of oxygen support up to 15 days (DAFOR15). Secondary endpoints included organ failure score, need and duration of mechanical ventilation up to 15 days, and all-cause mortality at 30 days. Exploratory endpoints included physiological parameters, biomarkers, and quality of life.</p></div><div><h3>Results</h3><p>From October 10, 2020, to December 09, 2020, 111 patients were randomized at thirteen sites in Brazil (56 to treatment and 55 to control group). Average age was 57.5 years, and most patients were male (68.5%). There were no significant differences in DAFOR15 between groups (5.9 ± 5.2 days for the intervention arm and 7.7 ± 5.1 for the control group; mean difference − 0.65, 95% confidence intervals from −2.95 to 1.36, <em>p</em> = 0.520).</p></div><div><h3>Conclusion</h3><p>Antisense therapy designed to block the kallikrein-kinin pathway did not demonstrate clinical benefits in increasing days-alive without respiratory support at 15 days in patients with COVID-19 during the first wave in 2020.</p></div><div><h3><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> Identifier</h3><p><span><span>NCT04549922</span><svg><path></path></svg></span></p></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"84 ","pages":"Article 154892"},"PeriodicalIF":3.2,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0883944124003794/pdfft?md5=c02b91df4fc585eb826de481dd846f71&pid=1-s2.0-S0883944124003794-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of complications in observational ICU admission after QT-prolonging drug intoxication","authors":"P.M.L. Zomer ,&nbsp;M.M. Deckers ,&nbsp;A.J.R. De Bie Dekker ,&nbsp;M.J.A. Kamps","doi":"10.1016/j.jcrc.2024.154860","DOIUrl":"10.1016/j.jcrc.2024.154860","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"84 ","pages":"Article 154860"},"PeriodicalIF":3.2,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to editor: Prophylactic versus restrictive platelet transfusion strategy in patients with haematological malignancies in the ICU setting, a propensity-score analysis","authors":"N. Motayar ,&nbsp;T. Haigh ,&nbsp;M. Tomberlin ,&nbsp;T. Kurth","doi":"10.1016/j.jcrc.2024.154890","DOIUrl":"10.1016/j.jcrc.2024.154890","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"84 ","pages":"Article 154890"},"PeriodicalIF":3.2,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venoarterial extracorporeal membrane oxygenation in high-risk pulmonary embolism: A narrative review","authors":"Eugene Yuriditsky ,&nbsp;Jan Bakker ,&nbsp;Carlos L. Alviar ,&nbsp;Sripal Bangalore ,&nbsp;James M. Horowitz","doi":"10.1016/j.jcrc.2024.154891","DOIUrl":"10.1016/j.jcrc.2024.154891","url":null,"abstract":"<div><p>Emergent reperfusion, most commonly with the administration of thrombolytic agents, is the recommended management approach for patients presenting with high-risk, or hemodynamically unstable pulmonary embolism. However, a subset of patients with a more catastrophic presentation, including refractory shock and impending or active cardiopulmonary arrest, may require immediate circulatory support. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) can be deployed rapidly by the well-trained team and provide systemic perfusion allowing for hemodynamic stabilization. Subsequent embolectomy or a standalone strategy allowing for thrombus autolysis may be followed with decannulation after several days. Retrospective studies and registry data suggest favorable clinical outcomes with the use of VA-ECMO as an upfront stabilization strategy even among patients presenting with cardiopulmonary arrest. In this review, we discuss the physiologic rationale, evidence base, and an approach to ECMO deployment and subsequent management strategies among select patients with high-risk pulmonary embolism.</p></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"84 ","pages":"Article 154891"},"PeriodicalIF":3.2,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141855667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic plasma exchange: A promising adjunctive treatment for tuberculosis-induced Hemophagocytic Lymphohistiocytosis?","authors":"Muhammad Ahmad,&nbsp;Muneeza Ijaz,&nbsp;Ali Israr Ahmed,&nbsp;Rukhsar Aftab","doi":"10.1016/j.jcrc.2024.154888","DOIUrl":"10.1016/j.jcrc.2024.154888","url":null,"abstract":"","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"84 ","pages":"Article 154888"},"PeriodicalIF":3.2,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine learning for predicting mortality in adult critically ill patients with Sepsis: A systematic review","authors":"Nasrin Nikravangolsefid ,&nbsp;Swetha Reddy ,&nbsp;Hong Hieu Truong ,&nbsp;Mariam Charkviani ,&nbsp;Jacob Ninan ,&nbsp;Larry J. Prokop ,&nbsp;Supawadee Suppadungsuk ,&nbsp;Waryaam Singh ,&nbsp;Kianoush B. Kashani ,&nbsp;Juan Pablo Domecq Garces","doi":"10.1016/j.jcrc.2024.154889","DOIUrl":"10.1016/j.jcrc.2024.154889","url":null,"abstract":"<div><p>Introduction: Various Machine Learning (ML) models have been used to predict sepsis-associated mortality. We conducted a systematic review to evaluate the methodologies employed in studies to predict mortality among patients with sepsis.</p><p>Methods: Following a pre-established protocol registered at the International Prospective Register of Systematic Reviews, we performed a comprehensive search of databases from inception to February 2024. We included peer-reviewed articles reporting predicting mortality in critically ill adult patients with sepsis.</p><p>Results: Among the 1822 articles, 31 were included, involving 1,477,200 adult patients with sepsis. Nineteen studies had a high risk of bias. Among the diverse ML models, Logistic regression and eXtreme Gradient Boosting were the most frequently used, in 22 and 16 studies, respectively. Nine studies performed internal and external validation. Compared with conventional scoring systems such as SOFA, the ML models showed slightly higher performance in predicting mortality (AUROC ranges: 0.62–0.90 vs. 0.47–0.86).</p><p>Conclusions: ML models demonstrate a modest improvement in predicting sepsis-associated mortality. The certainty of these findings remains low due to the high risk of bias and significant heterogeneity. Studies should include comprehensive methodological details on calibration and hyperparameter selection, adopt a standardized definition of sepsis, and conduct multicenter prospective designs along with external validations.</p></div>","PeriodicalId":15451,"journal":{"name":"Journal of critical care","volume":"84 ","pages":"Article 154889"},"PeriodicalIF":3.2,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141766159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}